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SUFFERING FROM A TOOTHACHE, a South Carolina woman headed to her local emergency room a few months ago. The doctor there responded by administering Dilaudid, a powerful intramuscular narcotic typically reserved for cancer-related pain. Why, his nurse queried, was he killing a flea with a sledgehammer? Afraid of malpractice? No, the doc replied, Press Ganey. "My scores last month were low."

Press who? The little-known company has become a hated target of hospital physicians, outstripping even trial lawyers. Utter its name in an emergency room and you'll likely unleash a cloud of four-letter words. Based in South Bend, Ind., Press Ganey is the nation's leading provider of patient satisfaction surveys, the Yelp equivalent for hospitals and doctors, and a central component of health care reform. Over the past decade the government has fully embraced the "patient is always right" model--these surveys focus on areas like waiting times, pain management and communication skills--betting that increased customer satisfaction will improve the quality of care and reduce costs. There's some evidence they have. An ObamaCare initiative adds extra teeth, to the tune of $850 million, reducing Medicare reimbursement fees for hospitals with less-than-stellar scores.

Catering to Patients Can Be Harmful to Their Health

Accordingly, hospitals kowtow to Press Ganey. In November nearly 2,000 administrators spent $1,100 or more each to attend Press Ganey's glittery client conference--a closed-to-the-public affair in Washington, D.C., with keynotes by Jeb Bush and astronaut Mark Kelly and his wife, former congresswoman Gabby Giffords. Press Ganey is helping hospitals fulfill their mandated obligation. Some have taken an extra step, tying physicians' compensation to their ratings.

That may sound like a good thing. Why shouldn't you grade the quality of your medical care, the way that you pass judgments on other services, whether hotel stays via TripAdvisor or contractors via Angie's List?

The short reason: The current system might just kill you. Many doctors, in order to get high ratings (and a higher salary), overprescribe and overtest, just to "satisfy" patients, who probably aren't qualified to judge their care. And there's a financial cost, as flawed survey methods and the decisions they induce, produce billions more in waste. It's a case of good intentions gone badly awry--and it's only getting worse.

FOR ALL THE DOCTORS OUT THERE CARPING about these surveys, a message from Press Ganey CEO Patrick Ryan, a veteran health care executive: Suck it up. "Nobody wants to be evaluated; it's a tough thing to see a bad score," he says. "But when I meet with physician groups I tell them the train has left the station. Measurement is going to occur."

But what exactly are Press Ganey and its two main rivals, the Gallup polling company and the publicly traded National Research Corp., measuring? Customers know what they want when they review spaghetti carbonara for Zagat. But giving patients exactly what they want, versus what the doctor thinks is right, can be very bad medicine. Last February researchers at UC Davis, using data from nearly 52,000 adults, found that the most satisfied patients spent the most on health care and prescription drugs. They were 12% more likely to be admitted to the hospital and accounted for 9% more in total health care costs. Strikingly, they were also the ones more likely to die.

Why? The UC Davis authors posit that the most satisfied patients have a higher mortality rate because they receive more discretionary services--interventions that carry a risk of adverse effects. Even routine screenings for diseases like prostate cancer can lead to unnecessary drugs and operations with allergic reactions and surgical complications that leave patients worse off. (While the report controlled for age and health status, critics have challenged its methodology and claimed its findings are overstated. But other studies also confirm that patient satisfaction is not always a reliable index of good care.)

"Numerous studies have found that patients are consistently highly satisfied with one of the most common downsides of medical care--false-positive test results and the downstream events that follow," wrote Dr. Brenda Sirovich of the VA Outcomes Group in White River Junction, Vt., commenting on the UC Davis study. "Almost any unnecessary or discretionary test has a good chance of detecting an abnormality." Such testing "is a double-edged sword," explains Dr. H. Gilbert Welch in his 2011 book, Overdiagnosed, often leading to "the detection of abnormalities that are not destined to ever bother us."

Our health care system already suffers from a "more is always better" fallacy. "Practicing physicians have learned--from reimbursement systems, the medical liability environment and clinical performance scorekeepers--that they will be rewarded for excess and penalized if they risk not doing enough," says Sirovich. An overreliance on patient surveys, she says, only inflames the problem of overtreatment.

Press Ganey's Ryan points the finger elsewhere: "If there's anything going on that's driving somebody to test more, it's the fear of malpractice." For the past few decades that's certainly been true. Money drives professional behavior for doctors, as it does for virtually everyone else, and the soaring insurance premiums that come with a malpractice suit have surely affected decision making.

But as hospitals and other employers increasingly tie physicians' compensation to patient wishes, doctors are pushed even further down the dangerous path of overtreatment. Nearly two-thirds of all physicians now have annual incentive plans, according to the Hay Group, a Philadelphia-based management consultancy that surveyed 182 health care groups. Of those, 66% rely on patient satisfaction to measure physician performance; that number has increased 23% over the past two years.